Max Bupa Heartbeat Gold Plan

Max Bupa Heartbeat Gold is a health insurance plan which covers 19 relations in its family floater variant. The plan provides all necessary coverage features including maternity cover and allows Sum Insured levels up to Rs.50 lakhs. Premium discounts are also allowed and the plan has optional coverage features too which can be taken to enhance the scope of coverage.

Key features of the plan

The plan has no sub-limits on room rents.

The family floater variant of the plan has two options. One is the simple family floater option which covers a maximum of 6 individuals. The other is a Family First option wherein 19 relations can be covered under the plan.

There are no limitations on Day Care Treatments. All treatments are covered by the plan.

There is no restriction on the entry age.

How does the plan work?

Step 1 – the policyholder chooses the Sum Assured, the plan variant, the term of the plan and the members covered.

Step 2 – If the covered member (s) face any medical contingency and the related expenses are covered by the plan the expenses incurred are paid by the plan.

Step 3 – if the plan matures and no medical contingencies occur, no benefit is paid.

Example

Vihan, aged 30 years bought an individual Heartbeat Plan for a Sum Insured of Rs.10 lakhs and a policy term of 1 year.

Option 1 – Vihan undergoes tonsillitis treatment which is a day care procedure. Since the plan covers day care procedures, Vihan’s bill of Rs.45, 000 is paid by the plan.

Option 2 – if the plan matures and Vihan doesn’t suffer any medical emergency, no benefit is paid.

Plan benefits

Medical benefits – the list of medical expenses covered by the plan and their extent is as follows:

For Family Floater and Individual Plans

Coverages

Sum Insured Rs.5 lakhs

Sum Insured Rs.7.5 lakhs

Sum Insured Rs.10 lakhs

Sum Insured Rs.15 lakhs

Sum Insured Rs.20 lakhs

Sum Insured Rs.30 lakhs

Sum Insured Rs.50 lakhs

In-patient hospitalization

Covered

Covered

Covered

Covered

Covered

Covered

Covered

Day care treatments

Covered

Covered

Covered

Covered

Covered

Covered

Covered

Pre-hospitalization

60 days

60 days

60 days

60 days

60 days

60 days

60 days

Post hospitalization

90 days

90 days

90 days

90 days

90 days

90 days

90 days

Domiciliary hospitalization

Covered

Covered

Covered

Covered

Covered

Covered

Covered

Organ Donor expenses

Covered

Covered

Covered

Covered

Covered

Covered

Covered

AYUSH Coverage

Covered

Covered

Covered

Covered

Covered

Covered

Covered

Maternity benefit

Up to Rs.40,000

Up to Rs.60,000

Up to Rs.70,000

Up to Rs.75,000

Up to Rs.80,000

Up to Rs.1 lakh

Up to Rs.1 lakh

New born baby cover

Covered up to Sum Insured

Covered up to Sum Insured

Covered up to Sum Insured

Covered up to Sum Insured

Covered up to Sum Insured

Covered up to Sum Insured

Covered up to Sum Insured

Vaccination for newborn baby

Covered for 1st year vaccinations

Covered for 1st year vaccinations

Covered for 1st year vaccinations

Covered for 1st year vaccinations

Covered for 1st year vaccinations

Covered for 1st year vaccinations

Covered for 1st year vaccinations

Ambulance cover

Network hospital – up to Sum Insured
Non-network hospital – Up to Rs.2000

Network hospital – up to Sum Insured
Non-network hospital – Up to Rs.2000

Network hospital – up to Sum Insured
Non-network hospital – Up to Rs.2000

Network hospital – up to Sum Insured
Non-network hospital – Up to Rs.2000

Network hospital – up to Sum Insured
Non-network hospital – Up to Rs.2000

Network hospital – up to Sum Insured
Non-network hospital – Up to Rs.2000

Network hospital – up to Sum Insured
Non-network hospital – Up to Rs.2000

Network hospital – up to Sum Insured Non-network hospital – Up to Rs.2000

Hospital Cash

Rs.3000/day

Health check-ups

Annually. Up to Rs.2500 per insured member

No Claim Bonus – if the policyholder does not make a claim in any policy year he earns a cumulative bonus of 10% increase in the Sun Insured subject to a maximum of 100% for family floater and individual plans. For Family First plan, the maximum allowable increase in Sum Insured is 50%.

Premium discounts – premium is discounted by 12.5% if a 2-year policy term is chosen. This discount is given in the second year’s premium.

Optional benefits – the policyholder can choose a co-payment of 10% or 20% to get further premium discounts.

Eligibility Criteria

Minimum

Maximum

Age at entry (in completed years)

Individuals of any age can be covered

Plan tenure

1 year

2 years

Premium paying options

Single pay

Sum Assured

Rs.1 lakh

Rs.50 lakhs

What is not covered by the plan?

Illnesses suffered during the first 30 days of the plan commencement are not covered.

Pre-existing illnesses or conditions are not covered by the plan in the first 2 years of the policy

Maternity related benefits have a waiting period of 2 years.

Specific illnesses are not covered in the first two years of the plan if the insured is aged 45 years or above. For individuals aged below 45 years, there is no waiting period for such specific illnesses

Illnesses or accidents caused due to genetic disorder or stem cell surgery, substance abuse, participation in adventure sports or hazardous activities, criminal acts, attempted suicide, war and hazardous substances, etc. are not covered.

Treatments like cosmetic treatments, artificial life support, weight loss treatments, non-allopathic treatments or due to HIV/AIDS, etc. are not covered.

Premium Illustration

Below is the sample rates of premium payable by a non-smoking male living in Mumbai for different combinations of age, plan variants and members covered. The Sum Insured is Rs.10 lakhs and the policy is taken for 1 year.

For a planned hospitalization, the insurance company should be informed at least 72 hours prior to hospitalization. For emergency hospitalization, the time period is within 48 hours of hospitalization.